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REPAIR , rather than replacing – a life changing difference on your mitral valve

While our bodies are usually good at signalling that something is off about our health , some illnesses can stealthily sneak up on us . One such condition is mitral valve regurgitation — a common type of heart valve disease that can lead to severe consequences if not treated in time .

Patients suffering from mitral valve regurgitation tend to experience shortness of breath , fatigue , and heart palpitations . In some cases , the condition can progress slowly , making such symptoms subtle and easily overlooked .

“ For some patients with the disease , it may take years for the symptoms to manifest ,” said Institut Jantung Negara ( IJN ) Senior Consultant Cardiothoracic Surgeon Prof Dato ’ Seri Dr Azhari Yakub . “ That ’ s why it ’ s so important to have regular checkups to make sure everything is in order . If you ’ re suddenly experiencing extreme fatigue , chest pains or breathing difficulties , it is always wise to consult a medical professional .”

As indicated by its name , mitral valve regurgitation affects the mitral valve separating the heart ’ s left chambers . The heart ’ s four valves act as one-way doors to ensure that blood continuously flows in the right direction throughout the body . When a valve is unable to close properly , blood can “ leak ” backwards across the valve — in severe cases , this dramatically reduces blood circulation and over time , it will weaken and lead to heart failure .

While risk factors for the condition include infections such as rheumatic fever , its exact cause is unknown . “ In our experience , it usually occurs among individuals aged between 40 to 60 , but we have seen even younger patients with the condition ,” added Dr Azhari .

Rescue via repair Conventional treatment for mitral valve regurgitation involves replacing the faulty valve entirely via open heart surgery . The use of artificial valves comes with its own set of complications ; patients with mechanical valves may need to be on blood-thinners for life to prevent blood clots , while valves with biological tissue risk failing over time .

“ Now , whenever possible , we prefer to repair rather than replace — this means reconstructing a patient ’ s own valve so that it can function properly ,” said Dr Azhari . “ The advantage of valve repair is that you preserve your own valve and have better heart function .” As an example , he cites the clinical guidelines issued by the European Association for Cardio-Thoracic Surgery , which recommends mitral valve repair as the “ surgical intervention of first choice ”. [ 1 ]

Dr Azhari is one of the pioneers of mitral valve repair in Malaysia , having performed it since 1992 and boasting a success rate of 90 to 95 %. He is also a leading opinion maker for this niche of cardiothoracic surgery within the

Asia Pacific , carrying out live surgery demonstrations at IJN and other countries such as Thailand , Vietnam , Indonesia , Bangladesh and Kazakhstan .

“ In the past , mitral valve repair usually had to be done during open-heart surgery ,” explained Dr Azhari . “ However , with new and recent medical advancements , we have had great success performing the procedure using minimally invasive techniques . Of course , the availability of this option will vary due to factors such as the severity of the disease .”

Another minimally-invasive option is the MitraClip , a small , catheter-based device designed to narrow the mitral valve opening . IJN was the first in Malaysia to introduce the MitraClip procedure in 2011 , and has since implanted the device in 100 patients — making the centre one of the few in the region to do so .

Dr Azhari added that as IJN frequently handles complex cases , the centre is constantly on the lookout for new and innovative approaches . “ We believe in taking a personalised approach as each patient ’ s needs are unique . Our aim is to offer patients a range of evidencebased options , and work together with them to tailor a treatment plan that is best suited for them ,” he said .

Prof Dato ’ Seri Dr Azhari Yakub Senior Consultant Cardiothoracic Surgeon

Patients suffering from mitral valve regurgitation tend to experience shortness of breath , fatigue , and heart palpitations .

GlobalHealthAsiaPacific . com ISSUE 6 | 2024

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